For more than two years, The Washington Post has relentlessly pursued the story of how a combination of corporate greed and government inaction fueled the deadliest drug overdose epidemic in recorded history. The causes and conditions of this massive—not to mention preventable—death toll are ripe terrain for a Pulitzer Prize–winning team of investigative journalists with a knack for data and science, who can also navigate the bureaucratic morass of government agencies that, in theory, should have sprung into action to tackle this unprecedented crisis.
The Post’s latest reporting has zoomed in on the ways in which President Obama, President Trump, and Congress failed to contain wave after wave of overdose deaths. A March 2019 investigation into Obama’s administration, titled “The Fentanyl Failure,” was the first hit in a series that revealed that the government had fallen down on the job: “Despite mounting deaths and warnings,” the reporters wrote, “the Obama administration did not take extraordinary measures to confront an extraordinary crisis.”
Two months later, the opioid team ran a lengthy piece, “Fighting Fentanyl,” that declared, “Trump called the opioid epidemic a priority, but fentanyl deaths soar as resources fail to keep pace.” Then, in September, the Post’s third article ran, this one focused on Congress’s inaction. “Flailing on Fentanyl,” another exhaustive, well-sourced investigation, concluded, “Congress failed to act despite dire warnings about the powerful opioid.” Members of Congress, consultants, career staffers, and legislative experts across the Beltway spelled out how powerful people elected to serve their constituents allowed the problem to metastasize.
But what, precisely, did all these powerful people and agencies fail to do? What “extraordinary measures” weren’t taken?
The policy prescriptions in all three Post articles overwhelmingly favor a narrow set of discredited actions, illustrating how conventional wisdom in Washington has perpetuated a dubious War on Drugs approach to addiction that hurts more than it helps. The same way a foreign policy blob of well-paid consultants, think tanks, and entrenched bureaucrats have trapped America in fruitless forever wars, the sources given credence in the Post’s opioid investigations inadvertently expose a fossilized drug policy consensus, one that goes back to the days when Richard Nixon declared “drug abuse” public enemy No. 1.
According to the Post, the failures run in just one direction: The Drug War was not enforced hard enough. And it’s the deadest of ends.
For example: During the Obama administration, the authors wrote, “U.S. Customs and Border Protection didn’t have enough officers, properly trained dogs, or sophisticated equipment to curb illegal fentanyl shipments entering the country from China and Mexico.” Later in the piece, former Deputy Attorney General Rod Rosenstein bemoaned “a dramatic decline in drug prosecutions” under Obama’s attorney general, Eric Holder. “That was a reflection of administration policy to de-emphasize imprisonment and to shift focus away from prosecution into treatment,” Rosenstein told the Post.
Even nominally prioritizing calls for more treatment over enforcement and incarceration is a bridge too far within the Drug War blob. What went unmentioned in the article is the fact that state imprisonment rates do not correlate in any meaningful way with drug use and overdose deaths; other studies have shown that incarceration itself is actually a driver of overdose deaths. People with an opioid use disorder exiting correctional settings are at a 40 to 130 times higher risk of fatally overdosing than the general population. The very policy solution being called for is actually what’s causing so many unnecessary deaths.
In the same piece, a former NYPD narcotics cop named Dominick Capuano also blamed Holder for prosecutors’ lack of interest in pursuing “low-level” drug cases, which Capuano claimed led to a morale problem among cops enforcing the Drug War. “The low-lying fish is where you start the cases,” Capuano told the Post. “Those are the people who flip, who give information, and that’s what leads to these bigger cases.”
Regina LaBelle, former chief of staff at the Office of National Drug Control Policy (ONDCP) under Obama, says she understands the criticisms about the Obama administration’s lackluster response to overdose deaths. “But I don’t agree that the policy response should have been shifted to more of a punitive response, like an increase in sentencing,” LaBelle told me. Instead, she emphasized that a lack of quality addiction treatment in the U.S. remains a major factor driving the crisis, not that more arrests aren’t being made.
The Post’s enforcement frame, applied to Obama, was peculiarly also applied to Trump’s “failure to act,” despite the fact that his first attorney general was Jeff Sessions, whom experts in drug policy called a “Drug War dinosaur.” In one of Sessions’s first major speeches in his new post, he emphasized a tough-on-crime, border enforcement strategy to the overdose crisis, while quixotically promoting debunked “Just Say No” drug education strategies. “In the ’80s and ’90s, we saw how campaigns stressing prevention brought down drug use and addiction,” he said. “We can do this again.” You can accuse the Trump administration of lots of things, but you cannot say they are “soft on drugs.”
Meanwhile, as deputy attorney general, Rosenstein promised to sue any programs that attempted to open facilities allowing people to inject drugs under medical supervision, called supervised consumption sites. More than 100 such facilities operate successfully across Western Europe, Canada, and Australia. During an unprecedented rise in drug deaths, the blob won’t even flirt with new public health–focused approaches. The Washington Post, for its part, neglects to open the door for innovative harm reduction strategies that go against the Beltway drug enforcement consensus. In contrast, the Canadian Broadcasting Corporation published a piece last June declaring that British Columbia’s death toll would be double what it is today without harm reduction.
The term “harm reduction” is part of a paradigm of pragmatic strategies aimed at keeping people who use drugs alive. It does not appear once in any of the Post’s three investigations. When reporting about Obama’s inaction, the Post did not mention that his administration lifted an absurd rule that prevented federal funding for syringe-access programs, but that when the House flipped back to Republican control, the ban was reinstated. (After a massive HIV outbreak in rural Indiana, Republicans partially lifted the ban.)
Other efforts, like doctors fighting to remove onerous
barriers
that prevent people from accessing life-saving medications like methadone and
buprenorphine, also go unmentioned. During the ’90s, when France implemented
what’s called a “low threshold model” that allowed any physician to prescribe
buprenorphine on-demand, the overdose death rate
plunged by 79 percent. Such a policy should be seriously considered stateside,
but unfortunately not by any sources quoted by the Post.
Which brings us to Congress. What, precisely, did Congress fail to do, aside from put communities at risk of HIV and Hep C by defunding syringe programs? The investigation spells out how Congress neglected to fully fund programs to the tune of many billions of dollars that experts like LaBelle argue are needed to rebuild America’s crumbling treatment infrastructure. Indeed, that’s a massive failure for which Congress is solely responsible. But other actions Congress failed to take, per the Post, involve bills collecting dust that would put sanctions on China, Mexico, and other countries that “aren’t cooperating with U.S. efforts to outlaw fentanyl.”
Highlighting bills that would sanction countries that source America’s demand for drugs illustrates the boundaries of what’s possible in drug policy. America has long flexed its Drug War muscles in countries like Colombia and Mexico by providing billions of dollars in military aid. For example, the DEA helped orchestrate the assassination of Pablo Escobar and the eventual capture, prosecution, and conviction of Joaquín “El Chapo” Guzmán. But America has no authority to fly attack helicopters into China, raid labs manufacturing fentanyl, or assassinate rogue chemists. The force of America’s global Drug War stops at China’s door, where the preferred strong arm of enforcement gives way to the soft arm of diplomacy. Given Trump’s so-called trade war with China, the diplomatic route seems to be going nowhere fast.
And of course, the flow of illicit drugs into the U.S. from Mexico did not stop after Guzmán’s capture. America’s presence in Colombia has also imploded in spectacular fashion. According to the United Nations, in recent years cocaine production in Colombia has hit new records.
“Countries that source America’s drug supply have been telling us the same thing for decades,” says Dan Ciccarone, a physician-researcher at the University of California in San Francisco who studies illicit drug supplies: “‘Deal with your [drug] problem, folks.’” Other countries around the world do not see the same astonishing rise in overdose deaths that occurs in the U.S. “Fun-loving, pleasure-seeking countries around the world do not have a drug problem as severe as ours is,” Ciccarone said. “And they all have rational drug policies: demand reduction and harm reduction, and we just haven’t done it.”
Focused on extending America’s global drug war and punishing countries that produce drugs, no Congress member quoted by the Post seemed curious to understand why Americans have an insatiable demand for substances that relieve pain stemming from trauma, economic hardship, and deteriorating living conditions. These politicians are witnessing an unprecedented decline in health among swaths of people in Appalachia, the Midwest, and New England—areas where free-trade policies caused factories to close and manufacturing jobs to disappear, putting the possibility of living a comfortable middle-class life out of reach.
Researchers recently linked free-trade policies to a rise in overdose deaths. For every 1,000 people who lost jobs due to free-trade policies that caused manufacturing jobs to disappear, there was an 11.3 percent jump in overdose deaths.
“People will say, ‘What’s the evidence for demand reduction?’ Well, why don’t we just give it a serious effort? Why don’t we fund a one- or two-generation serious effort like we’ve done with supply reduction?” Ciccarone asked. “Let’s work on community resilience, let’s work on individual resilience, let’s work on treatment and harm reduction to see whether it works.”
Ciccarone’s plea for a new drug policy paradigm is anathema to the square-jawed enforcers among Washington’s consultant class. Take, for instance, John Walters and David Murray, both of whom currently work at the conservative Hudson Institute in Washington. The duo were appointed to the ONDCP by President George W. Bush. They’re the authors of hits like “Kill All the Poppies,” a piece of pure hubris published in Foreign Policy that represents the Drug War at its most belligerent: crop eradication, crippling local economies, and cajoling other countries to stop feeding our drug habit.
Walters, who was frequently lambasted in his role as Bush’s drug czar for hiding from the press, was quoted in two out of the three Washington Post investigations. And the Post has also recently given a platform to Murray, who worked as “chief scientist” under Walters at ONDCP.
During a 2018 Washington Post forum, the moderator asked Murray what could go wrong with harm reduction. Murray’s response perfectly foreshadowed how the Post framed its opioid investigations: “I’m worried that we’re neglecting one of the critical tools here. ... If you’re not reducing the supply and availability [of drugs], you’re not enabling people to have incentives to move into treatment.”
The Walters and Murray theory of muscular drug enforcement has been the consensus in Washington for decades. And it clearly hasn’t worked, though you wouldn’t know that from the Post. “That’s what this is, a failure of imagination,” Ciccarone says. “We haven’t tried a new paradigm, and that’s the real failure.”